Technical Failure of Medial Patellofemoral Ligament Reconstruction

Reconstruction of the medial patellofemoral ligament (MPFL) has recently become a popular procedure for children and adolescents with patellofemoral instability. Nevertheless, high complication rates of up to 26% have been reported. The traditionally used technique requires patellar bone tunnels that may place the proportionately smaller patella at higher risk of fracture. Because of the adjacent physis of the femoral insertion, anatomic reconstruction of the MPFL has the risk of injury to the growth plate. This technical report therefore presents a technique for anatomic reconstruction of the MPFL in a skeletally immature population using a pedicled superficial quadriceps tendon graft, hardware-free patellar graft attachment, and anatomic femoral fixation distal to the femoral physis. The advantages of this technique include avoidance of bony patellar complications, an anatomically truer reconstruction, a single incision, and sparing of the hamstring tendons for reconstruction of any future ligamentous injuries.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Anatomic Reconstruction of the Medial Patellofemoral Ligament in Children and Adolescents Using a Pedicled Quadriceps Tendon Graft

Nelitz

Williams

2014

“…11,12 Because of the risk of patellar fracture, some surgeons advocate not drilling the patella. When we drill the patella using this technique, the tunnel is small (5 mm in diameter) and short (20 to 25 mm in length).…”

Section: Discussionmentioning

confidence: 99%

Medial Patellofemoral Ligament Reconstruction With Semitendinosus Autograft

Wylie

Burks

2013

Patellar instability is a common complaint after traumatic dislocation of the patella. Traumatic dislocation always leads to tearing of the medial patellofemoral ligament (MPFL). Treatment consists of recovery from the traumatic injury, followed by reconditioning and physical therapy to strengthen the dynamic stabilizers of the patella. In patients with recurrent instability, detailed evaluation of the cause is required to determine the needed interventions. In patients with an incompetent MPFL and recurrent instability, reconstruction is indicated, along with other procedures to address other contributing factors. This article details our technique for MPFL reconstruction using semitendinosus autograft, which can be performed alone or in concert with other realignment procedures.

“…Technical variationsdfor example, in the number of graft bundles, graft sources, and fixation methodsdexist, and much has been published on this topic in recent years. [1][2][3][4][5][6][7] However, because it is known that a nonanatomic reconstruction of the MPFL can lead to nonphysiological patellofemoral loads and kinematics, the goal of surgical intervention must be an anatomic reconstruction predicated on correct identification of the anatomic insertion sites of the MPFL on the patella and femur, secure fixation of the graft to the insertion sites, and appropriate graft tensioning. 8 We present a surgical technique for MPFL reconstruction using a looped gracilis tendon with suture anchor patellar fixation and suspensory loop cortical button femoral fixation.…”

mentioning

confidence: 99%

Medial Patellofemoral Ligament Reconstruction Using a Femoral Loop Button Fixation Technique

Godin¹,

Karas²,

Visgauss³

et al. 2015

Medial patellofemoral ligament (MPFL) reconstruction is a common procedure used to treat both acute and chronic patellar instability. Although many variations of MPFL reconstruction have been described, there is no consensus regarding the optimal surgical technique. We describe a technique for MPFL reconstruction with a looped gracilis tendon autograft using suture anchors to secure the graft to the patella and a suspensory loop button system for fixation to the femur. This technique replicates the native shape of the MPFL while minimizing the risk of patellar fracture and allowing for gradual tensioning of the graft.